Back in February, Alec MacGillis wrote an excellent piece for The Washington Post's Outlook section titled "Everything Is Political," in which he argued that it's okay for politics to be involved in our national policy-making.
At a time in which it seems that someone's always complaining that a decision was "political," his view was a refreshing one. And it helped to highlight an important question -- how should science and politics interact in public policy decision-making?
One of the examples he used to demonstrate his point was the controversy regarding the administration's decision that girls under 18 be required to get a prescription to buy Plan B, commonly known as the "morning-after pill." Proponents of making the Plan B drug available over the counter said that the science showed the drug to be effective and safe enough to purchase without a prescription off the drugstore shelf. But the administration took another view. They believed that while it may be safe and effective, they also asked whether it was good policy to make it available to girls 18 years of age and under without a prescription. Was this something our society was comfortable doing?
The central question was: Should science triumph all other considerations? Or should it be one of the factors considered when making decisions?
As a spokesman for the Department of Health and Human Services from 2001 to 2005, I was involved in this question when the Bush administration began to appoint new members to the various advisory committees within HHS and its agencies. Almost immediately we were charged with "politicizing science."
After eight years of a Democratic administration Republicans controlled the executive branch and all that went with it, including the appointment of members of hundreds of advisory committees. The Clinton administration had made its own appointments when it controlled government, as did the George H.W. Bush Administration previous to that and so on. What the issue was that some of the people we appointed had different points of view than the existing members of the various committees (whose terms were expiring, thus the new appointments).
If you don't think there are different points of view within the science community, all you need to do is attend a scientific conference. It is definitely a full-contact sport. And second, and most importantly, if you don't think there are competing views in science you don't understand the scientific process.
In one of science's most famous and important works, "The Structure of Scientific Revolutions," Thomas Kuhn posited that scientific advance is not characterized by inevitable evolution, but rather by "paradigm shifts" that occur when the foundations of "normal science" are challenged and undergo intellectual violence. Since then, while Kuhn's idea has been debated as to whether paradigm shifts are limited to just major advances or are more universal, his basic theory has taken hold.
Science is not a smooth process where everyone arrives at universal agreement. Instead, it is a competitive, intellectual battle. Not all people of science think alike; in fact, advancement happens when ideas bang into one another as Kuhn described.
Several examples in today's headlines demonstrate this point:
Vaccines: While demonstrated to be one of the great public health advances in the last 100 years, the safety and usefulness of vaccines were challenged by some in the late 1990s. In 1998 Andrew Wakefield, unscrupulously as we now know, ran an experiment to test a concern that the MMR vaccine caused autism. When his results were published in The Lancet, a firestorm of controversy followed. Families with autistic children were looking for an answer as to why their children had been afflicted with this syndrome, and Wakefield provided a possible answer. Particularly in the U.K. and to some degree in the United States, vaccine rates declined, leaving children vulnerable to previously unknown disease. What caused the controversy was that politics (politicians) intervened, giving credibility to the claim, which distorted the scientific process, delaying for years what should have taken only a short time to resolve. Eventually Wakefield's claim was demonstrated to be false. But the damage had been done, inoculation rates in the U.K fell and are still below what public health officials believe most effective for population protection. And there is now a permanent movement to reject the idea of the value of vaccinations.
BPA: BPA has been a chemical used in the manufacturing of plastics for more than 50 years. It is used to make products rigid and strong. Thousands of studies have been performed demonstrating its safety in levels humans are exposed to. These studies have been dominated by toxicologists. Recently, however, endocrinologists have begun to study BPA using different measures and outcomes to judge its safety. Their initial claims suggest BPA may not be as safe as claimed for the last 50 years. This is a clear example of Kuhn's theory in practice -- a competing idea has risen out of the academy to challenge the existing position. Unfortunately, instead of letting the scientific community hash it out, political advocacy has intervened as a means to push a specific agenda. But the good news is that so far, the scientific community, led by the FDA, has resisted the position of the advocacy community. The question is will they allow the scientific community, and can it, work its will. This is unclear.
Climate Change: The overwhelming scientific consensus is that our earth is going through a period of climate change, causing swings in weather conditions and temperatures. The question is whether this is the result of man-made causes or Mother Nature, since we know the weather has gone through great periods of weather change before. Politics has so perverted the climate change debate that it is difficult to understand it. However, because literally billions of dollars are at stake politics clearly has a role, but it seems the role is not to stop action but to direct it.
So how should science and politics interact in public policy making? Our evolving history of politics and advocacy points to a difficult path ahead.
Clearly, when scientific information and conclusions are central to public policy matters, it must be included in the decision making process. In many cases, it must be the dominant factor, such as in decision making by the FDA regarding market entry for a new drug. Politics cannot win this battle. But even here, because it involves a risk-benefit balance, as no product is without some level of risk, the answer is never without critics.
With vaccines, the safety battle, while a victory for science, lingers and most troubling, the impact appears permanent -- lower rates of vaccination of previously nearly nonexistent diseases, of which we now see occasional outbreaks. In the case of BPA, the advocacy world has aggressively entered the debate, using the scientific debate itself to try and gain a policy-making advantage. The question is whether science will prevail or will advocacy force a decision that may or may not be correct. And in climate change, politics has caused inaction, while the problem goes on.
As long as our public politics involves itself in scientific debate and tries to use the unfinished debate for a specific policy advantage the role of science will itself be a debate. This is unfortunate and something Kuhn never imagined when he explained how progress in science happens.
Author's Note: As a consultant with APCO Worldwide, Inc. I have worked on issues regarding vaccine safety and the safety of BPA. These opinions are my own.
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